Weaning Older Adults Off Sedatives After Hospital Stay

In a new study published in the Journal of the American Geriatrics Society, researchers investigated the efficacy of a new educational strategy designed to help older adults taper off sedative medications after hospital discharge.

As many as one in three older patients are given sedatives in the hospital, and many are given new prescriptions upon discharge. This can lead to a greater risk for falls, fractures, problems with thinking and making decisions, and even death.

In addition, older adults are at risk for dangerous side effects if they take several medications at once. Most concerning are benzodiazepines (Xanax, Valium, Klonopin) and non-benzodiazepine sedative hypnotics (Lunesta, Ambien, Sonata). These drugs are often prescribed for sleep, despite the fact that the American Geriatrics Society recommends they not be used as a first choice for sleep problems, agitation, or delirium (the medical term for an abrupt, rapid change in mental function).

The new study was based on earlier research suggesting that older patients who are being discharged be given the following: an educational brochure outlining the problems that sedatives pose and instructions for safely taking themselves off the medication.

In the earlier study, having this information helped 27 percent of older adults stop taking the sedatives, compared to five percent who didn’t receive the information. The researchers then designed the new study to investigate whether a brochure called “EMPOWER,” along with support from healthcare personnel at the time of hospitalization, could help older at-risk adults stop taking sedatives.

The study involved 62 patients aged 65 and older (average age was 79) who had been given prescriptions for sedatives at the Royal Victoria Hospital in Montreal, Canada. Nearly 70 percent were moderately to severely frail, and 42 percent said they had a fall within the past month. Frailty, a condition that affects 10 percent of people aged 65 and older, can make older adults more vunerable to disability, falls, hospitalization, and a shorter lifespan.

The study participants were given EMPOWER brochures and were encouraged to talk with members of the medical team if they wanted to stop taking sedatives. One month after their discharge from the hospital, researchers interviewed the participants about their sedative use as well as the quality of their sleep.

Among those who participated in the follow-up, 64 percent successfully stopped taking sedatives. That’s three times the number of people who were able to stop before the EMPOWER program was launched. Furthermore, 94 percent of the participants who stopped taking sedatives said their sleep problems were about the same as when they were taking medication.

The researchers conclude that the EMPOWER program is safe for hospitalized older adults. They note that more research is needed to see whether this kind of program could help reduce adverse drug events (serious side effects from medication) for frail older adults who take multiple medications for chronic health conditions.